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Methadone maintenance in primary care: a randomized controlled trial.

D A Fiellin1, P G O'Connor, M Chawarski

  • 1Yale University School of Medicine, 333 Cedar St, PO Box 208025, New Haven, CT 06520-8025, USA. david.fiellin@yale.edu

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Office-based methadone maintenance for stable opioid-dependent patients is feasible and effective. Primary care physicians can provide this treatment, with patients reporting higher satisfaction compared to traditional narcotic treatment programs (NTPs).

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Area of Science:

  • Addiction Medicine
  • Primary Care
  • Public Health

Background:

  • Methadone maintenance is a proven treatment for opioid dependence.
  • Current treatment is restricted to federally licensed narcotic treatment programs (NTPs).
  • Office-based care for stable patients is a promising alternative needing controlled trial data.

Purpose of the Study:

  • To assess the feasibility and efficacy of office-based methadone maintenance.
  • To compare primary care physician-led treatment with traditional NTP care for stable opioid-dependent patients.

Main Methods:

  • A six-month, randomized controlled open clinical trial.
  • Forty-seven stable opioid-dependent patients were randomized to either office-based care by trained primary care physicians or usual care at an NTP.
  • Outcomes included illicit drug use, clinical instability, patient/clinician satisfaction, and service utilization.

Main Results:

  • No significant difference in illicit opiate use or clinical instability between office-based and NTP groups.
  • Office-based care patients reported significantly higher satisfaction with care quality (73% vs 13%).
  • No differences were observed in functional status or use of health, legal, or social services.

Conclusions:

  • Transferring stable opioid-dependent patients to primary care physicians' offices for methadone maintenance is feasible and effective.
  • This approach enhances patient satisfaction.
  • Guidelines for patient selection and clinical monitoring are suggested.